Amy's Monthly Briefing - July 2020

Following the NHS's 72nd birthday last week, I'd like to say a personal thank you to the Royal London and the community health and care services that my young family and I have benefited from, and pay tribute again to the hard work of staff across all partner organisations as you continue to respond to the pandemic while moving into recovery.

This month the THT Board focused on user engagement, future governance, Covid-19 and inequalities, and the THT borough plan. We were a smaller group than usual, following the decision at the June meeting to slim down the membership and establish an executive level Board better able to drive momentum and make system-wide decisions.

First up, we approved a proposal from THT engagement leads for a 6-month co-production project on digital access to health and care services. Working with a wider group of partners in the health and care sector, including voluntary sector organisations supporting residents who face the biggest barriers to digital inclusion, we now have a clear picture of which groups are excluded from accessing online health and care services, and an increasingly detailed picture of what the barriers are. The project will bring together front line staff working on re-designing services with VCSE organisations and residents who are most excluded to develop and test ideas and solutions, ensuring consistent reward and recognition for everyone involved.

We then reviewed proposals for THT's future governance model. We confirmed the previous decision to streamline the executive Board, with a core purpose to oversee and drive forward borough-level integration, hold accountability for agreed system-wide resources and transformation priorities, and ensure patient voice is at the heart of our work. It's fair to say there was a robust exchange of views about the best mechanism for the operational group reporting into the executive Board, which should act as the engine room for delivery, building on the pace, innovation and operational freedom we have seen during the pandemic. My sense is there's a shared goal among partners to focus on delivery, reducing duplication and remaining fleet of foot in these uncertain times, but different views on the best way to get there. We all agreed we can't debate governance indefinitely, so follow up conversations are already underway to crack this.

We also heard feedback from a survey of lifecourse workstream members - thanks to those who took part. The key messages were that a majority of members across all three workstreams believe they add value to partnership working and overwhelmingly people want to retain them, but most felt they should be reformed. People proposed helpful ideas to improve the focus, capacity, accountability, pace and delivery of the workstreams, which we will be taking forward with the chairs. We need them to focus more on transformation priorities, innovation and engagement with service users and the voluntary sector, to avoid duplication with business-as-usual.

We had a presentation on the disparities in risk and outcomes of Covid-19 identified in the recent Public Health England report, outlining the stark implications for our borough. Tower Hamlets has the 4th highest death rates in London (when adjusted for age) and the report highlights the overlapping factors impacting on the pattern of Covid-19 in the borough e.g. deprivation, older population with worse health than elsewhere, ethnicity, occupation and diabetes as a major cause of poor health. We tasked the operational group to work with Public Health on an urgent action plan in response, using PHE's recommendations as a framework, to come to the next Board.

Finally, we reviewed the draft borough plan for THT which brings together existing priorities (refreshed just before Covid-19), emerging priorities identified at the last Board meeting and community modelling about reducing admissions at the Royal London. We identified immediate system-wide priorities to be considered by the Board: children's mental health following lockdown, inequalities and disparities arising from Covid-19, shielding the extremely clinically vulnerable, and urgent service areas requiring funding beyond temporary arrangements.

As ever, there is much to do within limited resource, but our goal as a Board is to focus more effectively on themes requiring a system response to unlock barriers and facilitate rapid, joined up solutions.